Excisional Biopsy of the Breast

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What is the test?

In an excisional biopsy of the breast, the surgeon makes an incision in the skin and removes all or part of the abnormal tissue for examination under a microscope. Unlike needle biopsies, a surgical biopsy leaves a visible scar on the breast and sometimes causes a noticeable change in the breast's shape. It's a good idea to discuss the placement and length of the incision with your surgeon beforehand. Also ask your surgeon about scarring and the possibility of changes to your breast shape and size after healing, as well as the choice between local anesthesia and general anesthesia.

How do I prepare for the test?

You'll undergo a breast exam and possibly a mammogram before the biopsy to determine where the lump is located. If you are having a sedative with local anesthesia, or if you are having general anesthesia, you'll be asked not to eat anything after midnight on the day before the surgery.

Tell your doctor if you're taking insulin, NSAIDs, or any medicine that can affect blood clotting. You might have to stop or adjust the dose of these medicines before your test.

What happens when the test is performed?

A surgical biopsy is done in an operating room. An IV line is placed in your arm so that you can receive medicines through it. The doctor may use local anesthesia with sedation to help you relax during the procedure, or general anesthesia. Surgical biopsies take about an hour, and the recovery period is less than two hours.

An open biopsy that removes only part of a lump of suspicious tissue is called an incisional biopsy; one that removes the entire lump is called an excisional biopsy. An incisional biopsy is usually done when the lump is quite large, since removing a larger lump completely can alter the appearance of the breast. This procedure is appropriate for larger lumps in order to secure a diagnosis while minimizing the effect on the breast's appearance. If the tissue proves to be cancerous, the remaining portion of the lump will be removed surgically during a second surgical procedure that may be more extensive and involve removal of lymph nodes to determine whether the cancer has spread.

When a breast mass or an area of calcification cannot be felt, the surgeon may choose to use a procedure called needle localization (or wire localization) to help identify the tissue for later surgical biopsy. The first part of this procedure is a mammogram. After applying a local anesthetic, the doctor inserts a hollow needle into the breast and, guided by ultrasound or mammography, places the tip of the needle in the suspicious area. He or she then inserts the front end of a thin wire with a hook on the end through the hollow needle and into the breast alongside the suspicious area. The doctor then removes the needle, leaving the wire in place to serve as a guide to help a surgeon find the area of breast tissue to be removed later.

What risks are there from the test?

Following a surgical breast biopsy, you'll have a short scar in the shape of a line. There may also be some distortion in the shape of the breast depending on its size, and the amount of tissue removed and its location. Expect to feel some soreness and swelling near the surgery site for a few days. There are also some risks associated with anesthesia, although the risk of general anesthesia is lower for breast surgery than for other forms of surgery, because the anesthesia isn't used for very long and the surgery is only slightly more than skin deep.

Must I do anything special after the test is over?

Medical staff monitor you for a few hours after your surgery to make sure that you're recovering well and not having any adverse reactions to anesthesia. Contact your doctor if you develop a fever, strong pain at the incision site, or bleeding from the incision. You may need a follow-up visit so that your doctor can remove stitches and make sure you are recovering well.

How long is it before the result of the test is known?

A preliminary report from the pathologist might be available when your surgery is over. A final report typically takes three to four days.

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